Bronchoscopy

Chapter 17 Bronchoscopy










6 What are the indications for bronchoscopy in the intensive care unit (ICU)?


Bronchoscopy allows inspection of the airways, collection of samples from the lower airways, and performance of various interventions (Table 17-1). In the ICU, it is most commonly used to diagnose infection via bronchoalveolar lavage (BAL) or protected specimen brush. In BAL, the tip of the bronchoscope is wedged into a subsegmental bronchus while aliquots of saline solution (typically 30 mL each) are injected and aspirated into sterile traps. Alveolar contents are collected while the bronchoscope position prevents flooding of other regions of the lung. The protected specimen brush is a sterile brush with a gelatin cap that is inserted into a potentially infected area, agitated, then withdrawn and sent for culture.


Table 17-1 Indications for bronchoscopy











































































Step Indication Goal
Inspection Hemoptysis Localize bleeding
    Search for endobronchial lesion
  Infection Identify evidence of inflammation or pus
  Aspiration Look for foreign bodies
  Mass Look for endobronchial masses
  Chest trauma Find evidence of airway injury
  Inhalational injury Find evidence of airway injury
Sample collection Pulmonary infiltrates (infectious) Obtain samples for Gram stain, silver stain, bacterial cultures, and viral and fungal studies
  Pulmonary infiltrates (noninfectious) Identify alveolar hemorrhage
    Check for eosinophilia (analyze cell count and differential)
  Mass or adenopathy Perform transbronchial biopsy for cytologic or pathologic analysis
Interventions Hemoptysis Control bleeding
  Bronchial obstruction Remove mucus or foreign bodies
    Perform laser removal of masses
    Place stent
  Alveolar proteinosis Perform lavage
  Intubation Visualize anatomy for tube placement

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Jul 6, 2016 | Posted by in CRITICAL CARE | Comments Off on Bronchoscopy

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